SPRING TALKS SEX - Choice denied

Monday, June 2, 2014 - 16:46

A law with teeth is only as good as its enforcement. But when a law is struck down, politics determines how it will play out in society.

When the Supreme Court struck down the law on abortion in 1988—the famous Morgentaler decision—a woman’s right to choose was enshrined in Canadian society. In 1989, the argument of “fetus as person” was rejected, as was the attempt by men in three provinces (Ontario, Quebec and Manitoba) to stop their partners from having abortions. These legal decisions left the right to choose firmly in the hands of individual women.

Women’s Legal Education and Action Fund (LEAF) decries these obstacles, particularly for women in rural areas, New Brunswick, Prince Edward Island and the North. They explain that provinces are able to limit access because abortion is on a list of “excluded services” in reciprocal provincial billing agreements. This means that women temporarily living outside their home province may not have access to publicly funded abortion care. Waiting for coverage is not feasible for a woman who chooses to terminate. For a woman who does not want to continue her pregnancy, every day that passes can be excruciating.

The Morgentaler Clinic in New Brunswick announced it would close its doors at the end of July 2014 after a lengthy losing battle to have that province fund clinic abortions, leaving local women bereft of an essential medical service. Moreover, for women in Prince Edward Island, the only province in Canada with no local access to abortion, women have had two choices: the Termination of Pregnancy Unit at the QEII Hospital in Halifax, where the costs of the procedure (but not those of travel or accommodations) are paid by the Province. At the Morgentaler Clinic in Fredericton, all costs have been privately paid by the woman (with many Island women accessing the Clinic’s subsidies). Over the years, roughly half of PEI women seeking abortions have used the services of the private clinic in Fredericton. The clinic was the only private option in the Maritime provinces. After the closure of the Fredericton private clinic, only one option will remain for Prince Edward Island women seeking a surgical abortion: travelling to the hospital in Halifax. (Read more about the current situation in PEI).

Why is this service essential?

It is estimated that 40 per cent of pregnancies in Canada are unplanned. A condom may break or slip, a pill may be forgotten, a woman may be sexually assaulted; or people may be unequipped to gain access to, negotiate or use contraception.

The decision to end a pregnancy is often based on economics, especially when she already has children and simply cannot afford to have another one. When money is tight and jobs are scarce, women think first of their existing children. When I had my abortion, we already had two children; the younger was a year and a half and our financial situation was precarious. Amongst the scores of pregnant women seeking help with their decision whom I counselled in sexual health clinics over the years, their distress was often financial.

But there were also more dramatic cases.

I vividly remember the woman who said she wanted to continue the pregnancy, but was afraid to. Her husband, who refused to allow her to use any form of birth control, had kicked her during a previous pregnancy. She had miscarried.

I remember the young woman who started having sex at 13 who had had three abortions and was a crack cocaine user. I am guessing that prior sexual abuse predisposed her to ongoing risk-taking.

I remember the 28-year-old who had been drugged and raped; the 16-year-old whose boyfriend wanted to trick her into getting pregnant.

These women all lived in a city where there was good access to services. But even when there is adequate access to the procedure, there is another component to the process which is as essential as the service itself. Every pregnant woman who came to the sexual health clinic where I worked was given the time to consider and explore her options. The counselling component is integral to the service of abortion referral and abortion provision. Counselling often leads to other service referrals, as in the case of the woman who was abused by her husband. It is expensive to pay people to help women make a fully informed choice. Whatever a woman chooses, she needs to feel that it is the right choice for her at that moment in her life. This can take time—and time is money. Counsellors who work in abortion clinics are supporting a woman who is facing a life-changing dilemma.

But health dollars are scarce and their distribution is political. For example, there is currently a lobby to extend HPV vaccination to boys despite the lack of evidence that it will save money in the long run. HPV DNA testing, which is part of good management for women over 30 is not covered by every province and territory. Pap screening and follow-up is not available to the women who are most at risk for cervical cancer. Mammography programs are not cost effective in terms of lives saved. Moreover, “potential harms considered by the [Canadian]Task Force [on Preventive Health Care] focus on over-diagnosis of breast cancer which can lead to additional imaging, biopsies and procedures, distress and other psychological responses, and additional radiation exposure from mammograms.” Yet women continue to be screened on a regular basis.

Women’s health facilities tend to be cash poor while hospitals are well-funded and able to raise huge amounts through donations.

Although the current federal government insists it will never reintroduce abortion legislation, they are choking funds for abortion services the same way they starve women’s organizations and women’s health clinics. If there was genuine concern about bringing wanted children into this country, there would be a national child care program and universal student nutrition programs.

Abortion is a medical procedure which should be accessible and fully funded—everywhere. It should be a priority for women to be able to choose when they want to continue a pregnancy and when they want to terminate one.

Women’s reproductive rights are central to their ability to control their lives. Without access to services and funding, the abrogation of a law is toothless.